Endoscopic visualization of lymphangitic spread of metastatic cholangiocarcinoma to the duodenum

A 74-year-old man presented with a 2-month history of obstructive jaundice. The result of CT of the abdomen was concerning for possible distal cholangiocarcinoma. EGD revealed a prominent major papilla with visibly dilated lacteals (A) and an area of mucosal abnormality in the second portion of the duodenum (B), with narrow-band imaging demonstrating punctate erythema (C). EUS demonstrated a 2 × 2 cm hypoechoic mass surrounding the...